Ambulatory surgery centers (ASCs) provide patients with a convenient option for same-day surgical care, and they are becoming an increasingly popular option for outpatient procedures.
 
According to the American Hospital Association’s TrendWatch Chartbook 2018, the number of outpatient surgeries has increased from more than 14 million in 1996 to more than 18 million in 2016. As the number of outpatient surgeries increases, so too has the number of ASCs. There were 5,532 Medicare-certified ASCs in 2016, up from 5,453 just one year earlier.  
 
As more surgical procedures are performed on an outpatient basis, ASCs offer an alternative to hospital admission. According to the 2017 Ambulatory Surgery Center Market Report, ASCs are expected to provide 60 percent of all outpatient surgeries by 2020.
 
This trend is beneficial in many ways. According to the Ambulatory Surgery Center Association, the decision to have procedures performed at ASCs results in savings of more than $2.3 billion each year for the Medicare program and Medicare beneficiaries.
 
However, there is also a downside to the trend. With the advent and expansion of ambulatory surgery centers (ASCs), there has been a gradual increase in medical professional liability (MPL) cases.
 
Ambulatory Surgery Allegations
 
Claims that occur in the ASC setting appear to parallel the same type of injuries as hospital-based surgical claims. For example, a review of Coverys MPL cases reveals the following allegations:
 
  1. Improperly performed colonoscopy causing splenic hematoma
  2. Nicked stomach lining causing sepsis
  3. Negligently performed liposuction causing permanent deformity
  4. Negligently performed ACL reconstruction resulting in below-the-knee amputation
  5. Perforation post-colonoscopy
  6. Negligently performed cataract surgery resulting in loss of eyesight
Over 55 percent of ambulatory surgery claims involve issues with the surgery or the procedure. Given the functionality of an ASC, this is not surprising. But, what is the nature of these surgical claims?
  

Figure 1. Allegation Categories – Ambulatory Surgery Claims
 
The top surgical risk management category relates to the technical performance of the surgeon. In 30 percent of ASC claims, the surgeon’s skill or technique was disputed. This suggests a performance issue. Behind technical skill, the next most frequent claim category was clinical judgmentdecision-making before or during the procedure, inadequate patient assessment, and less-than-vigilant patient monitoring.


Figure 2. Risk Management Issues – Ambulatory Surgery Claims
 
The Severity of MPL Cases at ASCs
 
One key distinction of ASCs is that they often stand alone. While this is often cited as a strength, it can also create greater patient risk. For example, when things go wrong in a hospital setting, there are plentiful resources available for immediate response. In contrast, at an ASC, thin resources can lead to catastrophic outcomes if the response is poor or delayed.
 
In that context, while 45 percent of overall MPL claims come from the outpatient setting and only 5 percent of those occurred at ASCs, it is important to understand the gravity of ASC events. A significant portion, specifically, 34 percent, resulted in permanent harm or death. If preventive actions are not proactively taken by ASCs, this case trend will continue to grow, resulting in even more tragic outcomes for patients.
 
Most MPL claims in the ambulatory setting originate in the physician office (diagnostic failures) or in the emergency department. While only 5 percent occurred in an ambulatory surgery location, these events are noteworthy because a significant portion of them (34 percent) result in high-severity injuries.  This statistic is higher than we normally see in non-hospital settings and is worrisome.                          
 
 
 Figure 3. Claims in Outpatient Locations
 
Risk Management for ASCs
 
If you operate an ambulatory surgical center, proper medical liability insurance is essential.

Coverys can provide an analysis of current risk management and patient safety processes, identifying potential gaps. You can measure your progress both with internal tracking and by monitoring your loss history and other quantitative risk management information. This is another tool to help advance your organization’s mission to improve patient outcomes and reduce the total cost of risk.

For more information, please contact Coverys. 
 

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No legal or medical advice intended. This post includes general risk management guidelines. Such materials are for informational purposes only. These informational materials are not intended and must not be taken as legal or medical advice on any particular set of facts or circumstances.